1447525431 NPI number — GENESIS PHYSICIANS GROUP,

Table of content: (NPI 1447525431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447525431 NPI number — GENESIS PHYSICIANS GROUP,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENESIS PHYSICIANS GROUP,
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447525431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2477
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48012-2477
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-270-7246
Provider Business Mailing Address Fax Number:
866-380-2182

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29777 TELEGRAPH RD
Provider Second Line Business Practice Location Address:
SUITE 2415
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48034-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-419-2416
Provider Business Practice Location Address Fax Number:
248-419-2374
Provider Enumeration Date:
03/09/2012

Additional Information

Authorized Official

Authorized Official Last Name:
GALOVICH
Authorized Official First Name:
ALLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLER
Authorized Official Telephone Number:
248-593-9780

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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